212 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
Many of the patient safety national initiatives have focused on inpatient care within
hospitals with few focused on primary care practices or specialty ambulatory care. The
Physician Practice Patient Safety Assessment (Medical Group Management Association,
2006) is a tool developed as a multidisciplinary assessment of patient safety practices
in ambulatory settings. Six domains are assessed including: medications; handoffs and
transitions between providers; surgery, anesthesia, and invasive procedures; person-
nel qualifications and competencies; practice management and culture; and patient
education and communication. These domains are the areas of highest risk and poten-
tial for safety concerns, which should be the focus of the practice’s patient safety pro-
gram development. The tool is free and available through the IHI website ( http://www.ihi
.org/ resources/ Pages/ Tools/ PhysicianPracticePatientSafetyAssessment.aspx ).
The IHI provides health professionals access to a wide range of QI and patient
safety tools and related training, as well as case studies of successful program imple-
mentation in actual practice sites throughout the United States. Through its Open
School, training is provided free to the public. The IHI (2016) Open School offers a basic
certificate of QI and patient safety on completion of 16 required courses in the areas of
improvement capacity; leadership; patient safety; person and family- centered care; and
quality, cost, and value. These courses are used by medical schools and other health care
professional schools in providing consistent training and access to well- conceived and
tested approaches to QI. Inclusion of this curriculum in DNP programs would provide
a consistent baseline of QI education within the context of interdisciplinary education
and approaches. Students are encouraged to reach beyond their educational programs
and join local and regional student- led quality initiatives. This model can teach the next
generation of health care professionals to apply the professional goals nursing has sup-
ported within the broader health care system.
■ SUMMARY
The nursing profession is poised to provide leadership in the transformation that is
needed in health care. Nurses have been acknowledged by health care leaders for their
respectability and reliability, particularly in the areas of QI and patient safety. In 2006,
the AACN proposed the role of a doctoral level advanced practice nurse who could
meet the demand for improved patient outcomes through the development of improved
patient- centered health care systems. There have been missteps and missed opportuni-
ties in the implementation of the DNP essentials related to quality improvement. There
has been a significant gap between the expertise of the faculty leading DNP programs
and the expertise needed to support students in the development of QI and patient
safety projects in health care settings. Again AACN (2015) has called for DNP programs
to reduce this gap significantly through faculty development and the use of national
initiatives in QI and patient safety including consistent use of definitions, standards,
and approaches in DNP education. This chapter has sought to bridge this gap by hav-
ing described key national initiatives pertinent to supporting advanced education in QI
and patient safety. In addition, resources were identified that are available to nursing as
well as other health care professions that could and should be integrated into DNP edu-
cational processes. Underlying these efforts is the recognition that nursing, as well as
all other health care professionals, must reduce the focus of discipline- specific strategies
and approaches directed toward QI. In its place must be the recognition of the multidisci-
plinary nature of health care delivery and the development of strategies and approaches
that are consistent with this reality. By joining these national multidisciplinary initiatives